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Community
4GI Development Group
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NEW SWIMMING POOL
PLAN SUBMITTAL AFFIDAVIT
Ordinance #2046
Please type or print
Date 5cAuari a-74 0.0I4
Propert Address' 73 g g W• A404 4e (-Av Ave. Pori c,i A z ts-18-
Name of Property Owner ,,,t,don t K:Mt3ulci Arneson
I. No children less than six years of age reside at this house.
II. ❑ A child under the age of six years of age resides at this house.
(If this box is checked, identify method of secondary pool
protection.)
A. _ We will provide an interior fence and enclosure around
the pool as required by the Glendale Pool Barrier
Ordinance.
B. ❑ We will provide exterior fence and enclosure protection
with secondary protection as checked on page two of
this affidavit per the Glendale Pool Barrier Ordinance.
(COMPLETE OTHER SIDE)
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Community
GI Development Group
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1 . .__ The pool shall be protected by a motorized safety pool cover.
2. _ Doors and windows protected.
3. _ . The pool shall be protected by an alarm maintained in or on the
swimming pool.
4. _ The above ground swimming pool shall have ladder secured.
5. _ Locking hard safety cover on the spa or hot tub.
6. . _ Alternative protection not specified above which is attached to
the plan 'submittal and submitted for approval by the building
official.
Zcoa 4 Aretesoi
Name of Home Owner (Print) , e Owner Signature Date .
SIGNATURE OF ER MUST BE NOTARIZED
PVeagtiA . Ltanaf 0/jea Usepy
Pool Contrast r (Print) ?Antra Signature Date
Notary Public State of Arizona
( �• Maricopa County
. - Tara Olson
d� AZ \/,' My Commission epiros 09H ono t s •
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y44slsov, o ) '& Cu%TU.,vAt once ofoqed
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